STAFF-ASSISTED HOME DIALYSIS DEMONSTRATION PROJECT.

SEC. 4202. STAFF-ASSISTED HOME DIALYSIS DEMONSTRATION PROJECT. (a) Establishment.— 104 STAT. 1388–105 (1) In general.—Not later than 9 months after the date of the enactment of this Act, the Secretary of Health and Human Services shall establish and carry out a 3-year demonstration project to determine whether the services of a home dialysis staff assistant providing services to a patient during hemodialysis treatment at the patient’s home may be covered under the medicare program in a cost-effective manner that ensures patient safety. (2) Number of participants.—The total number of eligible patients receiving services under the demonstration project established under paragraph (1) may not exceed 800. (b) Payments to Participating Providers and Facilities.— (1) Services for which payment may be made — (A) In general.—Under the demonstration project established under subsection (a), the Secretary shall make payments for 3 years under title XVIII of the Social Security Act to providers of services (other than a skilled nursing facility) or renal dialysis facilities for services of a home hemodialysis staff assistant provided to an individual described in subsection (c) during hemodialysis treatment at the individual’s home in an amount determined under paragraph (2). (B) Services described.— For purposes of subparagraph (A), the term “services of a home hemodialysis staff assist-ant” means— (i) technical assistance with the operation of a hemodialysis machine in the patient’s home and with such patient’s care during in-home hemodialysis; and (ii) administration of medications within the patient’s home to maintain the patency of the extra corporeal circuit. (2) Amount of payment.— (A) In general.—Payment to a provider of services or renal dialysis facility participating in the demonstration project established under subsection (a) for the services described in paragraph (1) shall be prospectively determined by the Secretary, made on a per treatment basis, and shall be in an amount determined under subparagraph (B). (B) Determination of payment amount.— (i) The amount of payment made under subparagraph (A) shall be the product of— (I) the rate determined under clause (ii) with respect to a provider of services or a renal dialysis facility; and (II) the factor by which the labor portion of the composite rate determined under section 1881(b)(7) of the Social Security Act is adjusted for differences in area wage levels. (ii) The rate determined under this clause, with respect to a provider of services or renal dialysis facility, shall be equal to the difference between— (I) two-thirds of the labor portion of the composite rate applicable under section 1881(b)(7) of such Act to the provider or facility (as adjusted to reflect differences in area wage levels), and (II) the product of the national median hourly wage for a home hemodialysis staff assistant and the national median time expended in the provision of home 104 STAT. 1388–106 hemodialysis staff assistant services (taking into ac-count time expended in travel and predialysis patient care). (iii) For purposes of clause (ii)(U)— (I) the national median hourly wage for a home hemodialysis staff assistant and the national median average time expended for home hemodialysis staff assistant services shall be determined annually on the basis of the most recent data available, and (II) the national median hourly wage for a home hemodialysis staff assistant shall be the sum of 65 percent of the national median hourly wage for a licensed practical nurse and 35 percent of the national median hourly wage for a registered nurse. (C) Payment as addon to composite rate.—The amount of payment determined under this paragraph shall be in addition to the amount of payment otherwise made to the provider of services or renal dialysis facility under section 1881(b) of such Act. (c) Individuals Eligible to Receive Services Under Project.— (1) In general.— An individual may receive services from a provider of services or renal dialysis facility participating in the demonstration project if— (A) the individual is not a resident of a skilled nursing facility; (B) the individual is an end stage renal disease patient entitled to benefits under title XVIII of the Social Security Act; (C) the individual’s physician certifies that the individual is confined to a bed or wheelchair and cannot transfer themselves from a bed to a chair; (D) the individual has a serious medical condition (as specified by the Secretary) which would be exacerbated by travel to and from a dialysis facility; (E) the individual is eligible for ambulance transportation to receive routine maintenance dialysis treatments, and, based on the individual’s medical condition, there is reason-able expectation that such transportation will be used by the individual for a period of at least 6 consecutive months, such that the cost of ambulance transportation can reason-ably be expected to meet or exceed the cost of home hemodialysis staff assistance as provided under subsection (b)(4); and (F) no family member or other individual is available to provide such assistance to the individual. (2) Coverage of individuals currently receiving services.—Any individual who, on the date of the enactment of this Act, is receiving staff assistance under the experimental authority provided under section 1881(f)(2) of the Social Security Act shall be deemed to be an eligible individual for purposes of this subsection. (3) Continuation of coverage upon termination of project.—Notwithstanding any provision of title XVIII of the Social Security Act, any individual receiving services under the demonstration project established under subsection (a) as of the date of the termination of the project shall continue to be eligible for home hemodialysis staff assistance after such date 104 STAT. 1388–107 under such title on the same terms and conditions as applied under the demonstration project. (d) Qualifications for Home Hemodialysis Staff Assistants.—For purposes of subsection (b), a home dialysis aide is qualified if the aide— (1) meets minimum qualifications as specified by the Secretary; and (2) meets any applicable qualifications as specified under the law of the State in which the home hemodialysis staff assistant is providing services. (e) Reports.— (1) Interim status report.—Not later than December 1, 1992, the Secretary shall submit to Congress a preliminary report on the status of the demonstration project established under subsection (a). (2) Final report.—Not later than December 31, 1995, the Secretary shall submit to Congress a final report evaluating the project, and shall include in such report recommendations regarding appropriate eligibility criteria and cost-control mechanisms for medicare coverage of the services of a home dialysis aide providing medical assistance to a patient during hemodialysis treatment at the patient’s home. (f) Authorization of Appropriations.—The Secretary shall provide for the transfer from the Federal Supplementary Medical Insurance Trust-Fund (established under section 1841 of the Social Security Act) of not more than the following amounts to carry out the demonstration project established under subsection (a) (without regard to amounts appropriated in advance in appropriation Acts): (1) For fiscal year 1991, $4,000,000. (2) For fiscal year 1992, $4,000,000. (3) For fiscal year 1993, $3,000,000. (4) For fiscal year 1994, $2,000,000. (5) For fiscal year 1995, $1,000,000.